Thursday, April 20, 2017

Strange EKG But That’s Fine by Me!



                
                If you’ve been following my blog, you are aware Levi underwent his 3rd ablation a couple months ago in the hopes of curing Wolff Parkinson White (WPW). WPW according to the Mayo Clinic’s definition is, “an extra electrical pathway between your heart's upper and lower chambers. It can cause a rapid heartbeat. The extra pathway is present at birth and fairly rare.” The reason for so many ablations is his WPW pathway was unique in that it was right next to his good pathway making the typical path to treatment a little trickier. Each time he left the hospital “cured,” only to have the bad pathway heal and come back weeks later.
                The third ablation his Doctor decided to go in from the left side, which isn’t typically done for an ablation with WPW. Levi left the hospital in a similar way as the last two ablations, “cured,” but with a wait and see attitude. The Doctor felt cautiously optimistic but again time would tell. This is where faith comes in. Everything was out of our hands so we went about life as usual. A few weeks after the procedure Levi had a heart monitor placed on his chest. This is standard after the ablation. The last two times Levi wore the monitor the results always came back with WPW being present and him having symptoms of SVT. He could still have the WPW pattern but if his heart didn’t go into SVT there would be no issue or risk from it. He wore the heart monitor for two weeks then mailed it back in to the Doctor.
(2017 Scott Firefighter Stairclimb post climb)
                During the two weeks Levi didn’t feel any symptoms as he had before. He did the Scott Firefighter Stairclimb shortly after his ablation and got over a minute PR. He attributed it to a better warmup and more conservative approach, I told him I thought it was because he was healed and his heart wasn’t going into SVT during exercise. Still only time would tell. While wearing the heart monitor he did pole vault practice and fought a fire, two things that would typically send him into SVT. Still he felt nothing. His heart rate dropped back down after exertion instead of staying elevated at over 150bpm for hours. Whatever was going on in his heart his Doctor would have good data to look at seeing that he doesn’t fight a fire that often let alone while wearing a heart monitor.
                On Good Friday Levi got a call from his Doctor. The Doctor told him he had had the results for about a day but was waiting to call him. He wanted to deliver good news but was worried he might hear from Levi that he was having symptoms. The heart monitor data showed that Levi still has a delta wave (pre-excitation) which is typically how WPW manifests itself. Basically, it means he will still have a somewhat abnormal EKG to the trained professional. But here’s the good news, the data showed he was asymptomatic! The ablation changed the way the heart pathway conducts so he doesn’t have episodes of SVT when he works out. This is great news! Levi is healed. He has to go back for a follow up appointment in one year but that’s it. It was definitely a good Friday. The day Christ suffered on the cross for our sins, to be our redeeming grace when he rose again. Dealing with the unknown forced me to have faith. I didn’t know what answers God would have for us but I had the faith to trust Him. If I can have the faith to know Christ lived a perfect life, endured the cross, and rose again, I can have the faith to trust Him even in the small obstacles I face in life. Next on the horizon, two small hernia repairs for yours truly. As much as I don’t like surgery or want to get it done, I’ll swallow my doubt and have a little faith.
(Doing training for the job he loves)

Sunday, March 26, 2017

Praise His Name in Dance

  “Let them praise His name in dance; strike up the band and make great music.” Psalm 149:3.

                I look forward to Sunday’s and going to church but with kids there are seasons (winter typically) where I feel like we barely can make it to church due to the constant runny noses, colds, and illnesses. On these days, I'm thankful to be able to listen to the sermons online. I joked to my husband that we had gone a few weeks without a sick kid so that meant we were overdue! Upon waking this morning, I went to help my oldest in the bathroom. She sounded a little congested. But she typically does in the morning. I had her blow her nose and nothing came out. She followed me into my room and I told Levi she sounded a little congested and said I didn’t know if we’d be able to take her to church. I didn’t want to risk her being at the start of a cold and getting other kids sick. I said we could go in shifts. One of us could go to the early service and one the later. Lily piped up and in a very sick (but obviously faking it voice) said, “I’m sick. I can’t go to church today.” Levi replied, “Maybe we could take her into church with us.” She immediately jumped for joy, “Yes! Yes! Yes! I want to go to the adult church with you!” She wasn’t sick but we decided to let her come with us for the morning worship.
                We told her she could stand and move around during the songs but when the pastor came to talk she had to be very quiet. As everyone stood and sang Lily got up and started dancing. We were sitting in the front row so she had quite the audience. But she wasn’t dancing for anyone. She told me later she was dancing for joy. She felt joy in her heart and she danced. The song was called, “Did You Feel the Mountains Tremble,” and one of the lyrics says, “Open up the doors and let the music play,
Let the streets resound with singing, Songs that bring your hope, Songs that bring your joy, Dancers who dance upon injustice.”
                Lily was holding nothing back. She was dancing her little heart out and I was moved to tears of joy watching her. In that moment, I felt the Spirit working through that little girl and bringing joy to others. As I looked around the room and on stage I saw smiles, wet eyes, and overall happiness as they watched her dancing for hope, for joy, for the Lord. Seeing an innocent child with a fresh heart feeling the world and letting her emotions go was inspiring.
                Another verse goes, “And we can see that God you're moving, A mighty river through the nations, When young and old return to Jesus, Fling wide your heavenly gates, Prepare the way of the risen Lord.” God was definitely moving, in that moment, in that room, through a little girl’s dance.
                After the song, the worship leader asked me what her name was. I told him and he said, “Lily, you are a beautiful dancer. Never stop dancing.”
                I pray that no matter what this world has in store, and I know there will be pain, heartache, and suffering, we can turn to Him and never stop dancing. 


"Did You Feel The Mountains Tremble?"
Hillsong United

Did you feel the mountains tremble?
Did you hear the oceans roar?
When the people rose to sing of
Jesus Christ the risen one

Did you feel the people tremble?
Did you hear the singers roar?
When the lost began to sing of
Jesus Christ the saving one

And we can see that God you're moving
A mighty river through the nations
When young and old return to Jesus
Fling wide your heavenly gates
Prepare the way of the risen Lord

Open up the doors and let the music play
Let the streets resound with singing
Songs that bring your hope
Songs that bring your joy
Dancers who dance upon injustice

Did you feel the darkness tremble
When all the saints join in one song
And all the streams flow as one river
To wash away our brokenness

And we can see that God you're moving
A time of Jubilee is coming
When young and old will turn to Jesus
Fling wide your heavenly gates
Prepare the way of the risen Lord

      
                If you are looking for a church in the Kent/Covington, WA area I encourage you to check out Faith Church. In April they are adding an evening service as well.

Tuesday, February 14, 2017

Mending a Broken Heart: Take Three



(Pre Ablation #2)
                In April 2016 I wrote the blog, A Healed Heart detailing Levi’s heart condition, Wolff Parkinson White (WPW). If you want more backstory on his heart condition and how an elite athlete like him even found out about his problem, see my previous blog. After reading that blog you would think everything was healed and fine. I didn’t write about it at the time but unfortunately the surgery was not successful.
                To cure WPW the electrophysiologist puts a catheter in the femoral vein and/or artery of each leg and runs multiple wires into his heart. They map the heart and find the unwanted accessory pathway, the “bad” spot, the pathway that shouldn’t be there that basically can let the heart conduct in a way it shouldn’t. When they find the pathway they either burn the spot or freeze it. Burning is the most effective method. Levi was not a candidate for burning as his accessory pathway is located right next to his normal pathway. If the Doctor were to bump the normal pathway this could cause his heart to stop. When working with burning, the results are pretty instant. When doing the freezing technique, there is a little leeway. If you accidentally touch the good pathway it may stop the heart but so long as you don’t continue to freeze, the tissue can “thaw” and the patient will be fine. If the Doctor touches the good pathway and stops the heart and it can’t recover, the only thing left is a pace maker.
                The Doctor Levi is working with has never caused heart block (where you have to put a pace maker in due to an unsuccessful ablation) in his 30+ years of practice. We feel in good hands. When the Doctor did the ablation the first time he froze the unwanted accessory pathway. His heart rhythm did not show WPW. The Doctor waited hours to make sure it didn’t come back. Upon leaving the hospital Levi was cured.  
Recovery after an ablation is very minimal and Levi was back at work a few days later. While on shift, he went on a fire call. The fire wasn’t huge and was easily contained. Levi didn’t end up in SVT (supra ventricular tachycardia) but after every fire the Firefighters go into rehab where they get fluids, food, and rest. In rehab the Medics come and check everyone out. With his WPW when Levi exerts himself he will go into SVT. His heart will start beating really fast and it will stay that way, sometimes for hours after. Since he didn’t have to exert himself his heart rate was fine. He asked the medics if they could do a 12 lead on him anyways. He was curious if he was cured from WPW. The Doctor had him scheduled for an appointment a month post operation but Levi figured why not check early to see? As soon as they ran the 12 lead EKG the words WPW appeared. His heart sunk. Apparently, he was not cured. He called to tell me the news. I was bummed. We knew there was a small chance of his heart healing itself and the bad pathway coming back and unfortunately for Levi he was one of the unfortunate few.
                 He told his Doctor and at his next appointment the Doctor had him wear a heart patch again to see what his heart was doing. There was a small chance that they damaged the unwanted accessory pathway enough that it wouldn’t allow Levi to go into SVT when he exercised. After two weeks Levi mailed in his monitor and awaited the results. They were as we expected, his heart was still conducting in a dangerous way. After talking with the Doctor, they scheduled another ablation.
                Upon operating on Levi, the first time, the Doctor discovered his accessory pathway is bumpable. That means if the pathway is even touched, it stops conducting, making it impossible to map/see. During the procedure, the heart is still beating. Imagine trying to zap an exact, tiny area with a small tool you are using through a vein, that you are looking at on a screen, all while your target is moving.  Saying it can be tricky is an understatement. This happened during the first ablation and the Doctor waited a couple hours and the accessory pathway eventually came back and he ablated again. During the second ablation, the pathway was bumped and it did not come back. Since the Doctor had mapped his heart out before he ablated the entire area and then some around where he knew the accessory pathway to be. He said he went as close as possible to his good pathway, even touching it which caused his heart to stop momentarily but quickly recovered since the freezing technique has more leeway in this regard.  They again waited for hours and it did not come back. Upon leaving it looked as though Levi was cured. The Doctor called me and told me how the procedure went, including bumping the good pathway, and that he felt confident they got the area. But Levi being a unique case, only time would tell.
(Levi finishing a 5km race or as he calls it, his marathon)
                Shortly after the second ablation Levi was scheduled for a yearly physical. He requested an EKG to see if he was cured. And for the second-time post ablation the screen read WPW. This was very disappointing. The routine was the same. Levi went in for his post op appointment and had a heart monitor strapped to his chest to see how things were conducting. Levi’s had WPW for as long as he can remember. He never knew anything was abnormal with his heart since he didn’t have major symptoms (like passing out) and thought the way his heart beat after exercise was normal. He now realizes what he thought was normal post exercise was in fact his heart going into SVT. He isn’t an endurance athlete so always thought he just didn’t recover as quickly after strenuous exercise due to being an anaerobic athlete.  I remember going on a hike with my family and Levi up the Grand Teton and my Dad hanging back with Levi as he was having a hard time recovering. We would take breaks and continue on our way feeling good but Levi would need more rest. My family and I are all endurance athletes so there was a little teasing on the part of Levi being a big muscular athlete who couldn’t keep up with the skinny distance runners. It was all in good fun but looking back we now realize he was suffering in SVT. I can’t imagine trying to exercise and having my heart rate stay well above its max for an extended period of time. No wonder endurance sports have not been his forte.
(At the top of Mailbox Peak, most likely in SVT, doing hand stands. 
If this is him with a heart condition,  
it's scary to think what healthy will look like!)
                After his second ablation Levi did hard track workouts, a track meet, and had a commercial fire that pushed his body to the max. He didn’t need to wait for what he already knew. The WPW wasn’t cured. He now knew what SVT felt like and he was definitely still having it. While on shift, he went on call for a commercial fire. Levi was working hard during this call. He sweated so much, the heart monitor patch came off. When he went into rehab the medics came over and took his pulse. His heart rate was high. Levi explained his situation and even showed them the heart patch the Doctor had put on his chest. The Medics said they still had to evaluate him per protocol so strapped a 12 lead to him. They saw WPW, which was expected, and that he was in SVT. The Medics told Levi to bear down. They wanted him to flex and hold his breath as sometimes this can get your heart out of SVT. Unfortunately for Levi his heart rate went higher, soaring to 217 bpm.
(Being evaluated by Medics post fire in SVT)
                The Medics put him in their rig and called the hospital for medical direction to see if converting him with adenosine would be acceptable to do. The drug is designed to stop your heart. Since Levi was already working with a heart doctor and this is what they would do to convert a regular patient the hospital said it would be acceptable to do. The Medics put an IV in Levi’s arm and administered one does of adenosine. It didn’t work. They doubled the dose and did it again. They told him to stay calm and take deep breaths as it can freak people out when their heart stops. When his heart stopped, Levi said he felt heat and pressure all over his body. It stopped his heart for 5-6 seconds. It worked. His heart restarted and immediately dropped from 140bpm to 90bpm in an instant. He said he felt amazing. He later recognized the feeling when his heart stopped as suffocation. Like if you dove deep under water and struggled to get to the surface before running out of air.
                The elctrophysiologist had a lot of good data after the heart monitoring and just as expected he was still in SVT. At his next appointment, the Doctor discussed the option of medication. The reason they hadn’t gone that route is because Levi’s heart rate gets very low at night. During monitoring, it would drop as low as 21 bpm. Since the medicines can slow your heartrate they would not be an ideal option. Levi wondered what would happen if the drugs made his heart rate go too low at night? How would he know? The Doctor said they would keep him over night in the hospital for a night or two in case his heart rate got dangerously low. He talked with me about the options and neither of us liked the drug option. He emailed his Doctor with questions about doing another ablation and was relieved to find out the Doctor was completely fine with doing another ablation. Sometimes patients want to see results and don’t want to continue doing surgical options without result. Since Levi was fine with going in as many times as the Doctor saw fit they went ahead and scheduled another ablation.
Levi’s Doctor brought up his case with his other colleagues and after discussion, he decided he is going to try and go in from the left side of Levi’s heart. Ablations are typically done going in via the right side. The left side is a different approach for his condition. There is a slightly higher risk of a blood clot traveling to the brain since the left side of the heart has arteries that lead to the brain. The Doctor will give Levi a blood thinner to lessen the risk.  Levi’s accessory pathway is in the wall that separates the two sides of the heart so the Doctor may be able to access it from the left side of the heart. The Doctor will go in and first map the area to see if there is a window of opportunity to get to the area. If there is they will ablate, if not, he will pull out and we will go from there and see what options we have. 
For some inspiring and uplifting thoughts, I’m resharing a video of Levi vaulting. I love this video. It was taken while Levi was wearing his heart monitor after his second ablation. After his doctor reviewed the data he saw that Levi was in SVT during his vaults and there was a marker where a button on the monitor was pushed. The button is used to mark when you feel something weird. It got pushed when Levi’s friend tackled him onto the pit in celebration. The video shows the clutch vault that Levi took that qualified him for the 2016 Olympic Trials. Levi took a risk, on his opening height he put the bar at a PR (it is very rare for anyone in pole vault to open at a PR), and on his third attempt made it. Let’s hope the third ablation attempt will yield the same result. I have faith.